Should I Lie About My Beliefs to Get Health Insurance?

Boulder, Colo. — HERE’S an ethical dilemma. If you could save your family more than $8,000 next year simply by signing a statement affirming belief in principles you find repugnant, would you?

It sounds absurd. But in fact that’s the position I’m in this week, thanks to a loophole in the Patient Protection and Affordable Care Act, otherwise known as Obamacare. My health insurance poses a financial hardship to my family. All I have to do to lower my yearly bills by thousands of dollars is use my John Hancock to denounce gay marriage and a woman’s right to control her reproductive destiny.

By Dec. 15, like many Americans, I need to choose a new health insurance plan for 2017. I am a freelance journalist and editor. My husband runs a small business that pays him a salary but no benefits. We are among the millions of Americans who, under the Affordable Care Act, buy individual insurance through an increasingly expensive and inadequate marketplace. Since the law went into effect, monthly premiums for my family of three have already more than doubled, from $450 a month to $930. (In Colorado, my home state, 2017 rates are on average 20 percent higher than they were in 2016; in some counties that number is 40 percent.) On top of that, high deductibles mean we pay for nearly everything ourselves. In 2016, between monthly premiums and out-of-pocket costs, we’ve spent roughly $20,000 on health care.

Our new plan, the fourth in four years, is being discontinued, so we must again seek new insurance. We don’t qualify for federal subsidies. I’ve got six months of 2015 insurance premiums accruing interest on a credit card, and a $4,200 bill for a four-hour emergency room visit sits menacingly on my desk. The number of insurers offering individual plans in Colorado, as in many other states, has dwindled; there are now only three companies — Anthem, Cigna and Kaiser — left in our ZIP code. (In 14 Colorado counties, there is only one provider offering plans.) Only one of our longtime doctors participates in any of these 2017 A.C.A.-plan networks.

I support the Affordable Care Act. Before it took effect, my husband was once denied coverage on the grounds that he’d seen a doctor for a sinus infection; I was charged hundreds of dollars above the quoted rate because of a long-ago surgery with no lasting health impacts. I know people whose lives the Affordable Care Act has transformed, friends with pre-existing conditions that had made them uninsurable but who now can get the coverage they need. My support for the law comes from a belief that access to affordable health care should be an undeniable right. But the battle to get it passed produced a deeply, perhaps fatally, flawed law — and on a personal level, my quality of life has declined under the A.C.A.

There are now a growing number of theoretically less expensive health care options that don’t comply with the Affordable Care Act. I could, for instance, join a local membership-based primary care provider clinic — around $200 a month for a family of three — and combine it with a similarly priced catastrophic-coverage plan. But these options still leave gaps in your coverage, and subject you to a fine for not carrying proper insurance — up to 2.5 percent of your adjusted gross income.

There is, though, one more option available to me. For only $500 a month — a saving of $8,400 a year in premiums over the Anthem plan we are considering — I could purchase coverage through a “faith-based plan” called Altrua HealthShare. Officially known as “health care sharing ministries,” such plans are not, strictly speaking, insurance. According to the Alliance of Health Sharing Ministries, “The purpose of the ministry is simply to organize other people who voluntarily choose to help fellow members pay their medical bills in keeping with biblical commands to ‘share one another’s burdens.’ ”

But in practice, the ministries serve much the same function as insurance. Members pay a monthly contribution, they are subject to an annual deductible (in this case, $1,000 per person) and their doctor submits a claim and is reimbursed by the plan.

Faith-based plans do not adhere to the same rules as Obamacare insurance plans. They don’t have to pay for preventive care, they may not insure smokers, they may not cover pre-existing conditions, and they may deny you admission based on your weight. If you are a 5-foot-6 woman and weigh more than 230 pounds, for instance, Altrua HealthShare won’t offer you membership. Unlike the other non-A.C.A.-compliant options, though, health care sharing ministries are actually exempt from the law. (These organizations have to meet certain requirements, and must have been in existence continuously since 1999.) That means if you sign up for one, you aren’t subject to the fines.

While some health sharing ministries require membership in a Christian congregation, Altrua HealthShare does not. My family’s doctors all participate in its extensive network. According to its guidelines, membership “is based on a religious tradition of mutual aid, neighborly assistance and burden sharing.” Sounds promising. Membership, Altrua’s brochure continues, “is specifically tailored for individuals who maintain a healthy lifestyle, make responsible choices in regards to health and care, and believe in helping others.” I bike, hike and practice yoga; I’m a longtime vegetarian; I’ve never smoked. And who doesn’t believe in helping others?

Here’s the catch. In order to join, you have to agree to a “statement of standards.” Among the list of seven principles are these three: “According to the Word of God, sexual relations outside the bond of marriage is morally wrong.” “Marriage is a bond between a man and woman only.” “Abortion is wrong, except in a life-threatening situation to the mother.”

I disagree with each of these. And the last I checked, premarital sex, same-sex marriage and abortion were legal in the United States. Still, I considered consenting to the “standards” for the sake of my family’s financial situation. Imagine if we could put money away for college tuition, or pay down our credit card debt, instead of sending thousands to a giant corporation. What if I swallowed my principles and sent a contribution to Planned Parenthood as penance?

But in the end, I simply couldn’t do it. Much like many of these ministries’ members, I believe certain principles are sacred. (Altrua won’t pay maternity benefits if the pregnancy arose through “adultery or fornication by the member.”) For those on the religious right, their beliefs grant them exemption from federal law, and access to decent affordable health care. Unfortunately, there’s no such loophole for clean-living, charitable nonbelievers.

So next week, I will sign up for a plan that costs nearly $1,200 a month and that will still pay for next to none of my family’s medical needs. I will have to part ways with the O.B. practice whose doctors saw me through a complicated pregnancy and delivered my son healthy. Because I hold one set of beliefs about right and wrong, I am subject to federal law. If I subscribed to a different set of morals, I would be exempt from its clutches.

Roughly 625,000 people belonged to health sharing ministries as of September; that number is sure to rise as people like me balk at their diminishing options. As Republicans grapple with the Affordable Care Act, it would be wise for them to keep in mind that, like it or not, America is composed of people with different backgrounds, ethnicities and beliefs. The answer is not to repeal the law, which could result in more than 23 million Americans losing their coverage. The answer is to find solutions that allow all working families to find affordable health care that doesn’t demand choosing between their ethics and their ability to provide for their children.